Blue Access for Employers

Frequently Asked Questions about
BlueEdgeSM HSA Plans



What is BlueEdge?

BlueEdge is a consumer-driven health plan that works with a spending account option – a Health Savings Account (HSA) – that you and/or your employees may fund. BlueEdge gives members control over how they spend their health care dollars and includes four major components:

  1. HSA funds from you and/or your employees are used to pay for covered health care expenses. Money spent from this account, for covered services, counts toward the deductible.
  2. PPO benefits begin after members meet the deductible. They have the freedom to see any doctor without a referral.
  3. Preventive care and wellness visits are covered – nothing is deducted from the spending account and employees don't need to meet the deductible to enjoy these benefits.
  4. Online decision resources help increase members' awareness and knowledge of health issues and help them keep track of HSA and health care expenses.

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How is BlueEdge different from a traditional health plan?

Most traditional plans pay a percentage of the charges for covered medical expenses only after the member satisfies a plan deductible or copayment. With BlueEdge, your employees' preventive care and wellness services are covered without first meeting the deductible. You and/or your employees may also set aside a specific amount of money each benefit year in an HSA. The HSA funds pay for other covered health care expenses that are also applied to the deductible. Your employees pay the remaining deductible amount and then PPO benefits begin. Any funds in your employees' HSAs are theirs to keep, even if they change jobs or stop working.

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What is a Health Savings Account (HSA)?*

An HSA is a tax-favored savings account that members use with a high-deductible health insurance plan such as BlueEdge. The HSA can be established with funds from you, your employees, or both. The money in an HSA helps pay the deductible, as well as any other eligible medical expenses (including coinsurance) that may not be covered by the health plan after the member meets the deductible.

An HSA is similar to an individual retirement account (IRA) because it can be invested in a variety of investment vehicles while accumulating tax-free interest. However, HSA funds are not taxed when withdrawn to pay for qualified medical expenses. Employees can make withdrawals from their HSAs for nonmedical expenses, but the withdrawals will be taxed as normal income and subject to a tax penalty (if withdrawn before age 65).

At the end of each year, any unused funds in your employees' HSAs remain in their accounts and continue to earn interest tax-free.

HSA funds are portable, which means employees own their accounts. Even if employees switch jobs, the funds stay with them.

For more information about HSAs, go to www.irs.gov .

* HSAs have tax and legal ramifications. The information provided herein is for informational purposes only and is not intended as tax or legal advice. Consult a tax or legal professional for advice regarding HSAs.

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How do my employees use the funds in their HSAs?

Using funds in an HSA is easy. Typically a financial institution will provide the member with a debit card and/or a checkbook. For example: When a member needs to visit the doctor and pay for a qualified medical expense, he or she uses the debit card or check to make the payment. They will receive more information regarding how to access funds from their HSA administrator/bank.

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What are qualified medical expenses?

HSAs can be used to pay for many types of medical expenses, even some which are often excluded on health insurance plans. These include:

  • Health insurance plan deductibles, copayments, and coinsurance
  • Prescription and over-the-counter drugs
  • Dental services, including braces, bridges, and crowns
  • Vision care, including glasses and lasik eye surgery
  • Psychiatric and certain psychological treatments
  • Long-term care services
  • Medically related transportation and lodging

Check with your tax advisor or go to www.irs.gov  to obtain a current list of qualified medical expenses as determined by the IRS.

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Can my employees use their HSAs to pay for non-health-related expenses?

Members may withdraw money from their HSAs for items other than qualified health expenses; however, that money will be subject to income tax, and if the member making the withdrawal is under 65 years old, there will be an additional tax penalty on the amount withdrawn.

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What is the BlueEdge HSA Plan deductible?

Like most other PPO plans, BlueEdge includes an annual deductible. A deductible is a fixed amount the member is required to pay before health care benefits begin. The HSA pays a portion of the deductible and the member is responsible for paying the remaining part. Please note that certain expenses can be paid from the member's HSA, but may not qualify toward the deductible.

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How does the BlueEdge HSA family deductible work?

The family deductible is an aggregate deductible, which means that the entire family deductible amount must be satisfied before benefits begin for any family member.

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Do my employees have to pay for preventive medical services from their HSAs?

No. Most preventive medical services (e.g., routine physical exams, age-based testing, and vaccinations) are covered at 100 percent under BlueEdge when the member receives care from in network doctors. Check your group plan documents for specific coverage details.

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What covered services will my employees have to pay for out of their own pockets?

There are three circumstances when a member will have out-of-pocket expenses:

  1. The member has used all his or her HSA funds, but has not yet met the deductible. The member is responsible for paying for health care services until the deductible has been satisfied.
  2. The member has met the deductible, so PPO benefits are available. If your plan includes coinsurance, the member will be responsible for paying a percentage of the charges. There is an out-of-pocket maximum, so the member won't pay more than this amount during the benefit year as long as services are received in network. Check your plan documents for specific coverage details.
  3. Non-covered services, additional coinsurance (until the member meets the higher out-of-pocket limit), and charges in excess of our allowed amount when services are received out of network.

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Can the unused funds in my employees' HSAs be rolled over each year?

Yes. Your employees' funds will accumulate without a maximum limit.

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For how long can my employees keep their HSAs?

Your employees own their HSAs and can take them from one job to the next. They can even use their HSAs when they retire.

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How does the prescription drug plan work?

BlueEdge HSA features a 25/50 percent prescription drug benefit.

The copayment for prescription drugs purchased through this drug plan is 25 percent of the covered charge for generic drugs and 50 percent of the covered charge for brand-name drugs. If the percentage of the covered charge falls between the minimum/maximum copayment, the member will pay the actual percentage amount.

Prescription Program for Enhanced, Basic, Premier Only Percentage Member Pays Minimum Amount Maximum Amount
Retail Pharmacy: Up to a 30-day supply or 180 units, whichever is less.**      
     Generic drug 25% $20 $75
     Brand-name drug 50% $40 $125
PrimeMail Pharmacy Mail-Order Service: Up to a 90-day supply or 540 units, whichever is less.**      
     Generic drug 25% $40 $150
     Brand-name drug 50% $80 $250
Prior-approved enteral nutritional products and special medical foods. 50% N/A – member pays 50% N/A – member pays 50%

The copayment will never exceed the maximum copayment listed. Copayments are applied to the medical plan annual out-of-pocket limit. Advise your employees to fill prescriptions at a participating pharmacy (search the Provider Finder®) or through the PrimeMail Pharmacy mail-order service. Coverage is always subject to the limitations of your group’s health care plan. For some medications, prior approval, generic substitution, or quantity limits may apply. See your Prescription Drug Plan Rider for details, limitations, and exclusions.

The BCBSNM Drug List does not apply to the 25/50 Percent Prescription Drug Plan.

** BlueEdge HSA 100 Prescription Drug Plan – Retail/Mail-Order, Generic and Brand-name drugs are subject to a deductible then the plan pays 100%. The same limits and prior authorization rules apply.

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What if my employees have questions about their benefits?

BCBSNM's customer service representatives are available to answer questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on weekends and holidays (closed Thanksgiving and Christmas Day). If members call after hours, they can leave a message and we will return their call by the next business day. They should call the toll-free number printed on the back of the member ID card and they should have their ID card available when they call. They may also contact customer service with a secure message through Blue Access for MembersSM.

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Learn More About BlueEdge HSA

Overview
Benefit Information
How BlueEdge HSA Works
Spending Account and the Deductible
Easy steps for setting up an HSA
Common FAQs

 

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